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Fever of unknown origin (peds)
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Contents
Background
- Prolonged fever of unknown origin without identified cause generally has favorable prognosis.
Clinical Features
- Original definition[1]
- Fever >38.3 C on several occasions
- Lasting for at least 3 weeks
- No clear diagnosis after 1 week inpatient workup
- Newer definition[2] - "Prolonged fever" with:
- 3 outpatient visits without identifying a cause or
- 3 inpatient days without identifying a cause or
- 1 week of “intelligent and invasive” ambulatory investigation
Differential Diagnosis
- Infection
- Bacterial
- Adenitis
- Endocarditis
- Mastoiditis
- Occult abscess
- Pyelonephritis
- Sinusitis
- Tb
- Viral
- CMV
- Hep A,B, C
- Mono
- Chlamydial
- Lymphogranuloma venereum
- Psittacosis
- Mycoplasmal
- Fungal
- Blastomycosis
- Cysticercosis
- Histoplasmosis
- Rickettsial
- Q fever
- Rocky Mt
- Parasitic
- Malaria
- Toxo
- Bacterial
- Non-infectious Inflammatory
- JRA
- LSE
- Regional enteritis
- Rheumatic fever
- Ulcerative colitis
- Vasculitis
- Malignancy
- Leukemia
- Lymphoma
- Neuroblastoma
- Wilm's tumor
- Drug Induced
- Antibiotics
- Anticonvulsants
- Anti TB
- Procainamide
- Quinidine
- Serum sickness
- Misc
- AIDS
- CNS
- Environmental
- Factitious
- Familial dysautonomia
- Kawasaki
- PE
- Serial infections
- Thyrotoxicosis
Evaluation
- Clinical (preliminary) diagnosis
Management
- Treat underlying cause (once identified)
- Empiric treatment generally not recommended
Disposition
- Frequently admitted for workup
See Also
References
- ↑ Kaya A, Ergul N, Kaya SY, et al. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther. 2013 Aug;11(8):805-15.
- ↑ Durack DT, Street AC. Fever of unknown origin--reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51.
Authors
Michael Holtz, Ross Donaldson, Neil Young, Daniel Ostermayer
